MedicaidAdministrativeHigh impact
PT 32-26: Correction to PT 13-26 Requirements for Providers Referring to Psychiatric Rehabilitation Programs
Maryland Medicaid·MD · Psychiatry·Provider Transmittal
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Maryland Medicaid corrects PT 13-26 to clarify that only fully licensed mental health practitioners who can independently practice and enroll as Medicaid providers can refer patients to Psychiatric Rehabilitation Programs (PRPs). Licensed graduate-level practitioners (LMSW, LGPC) cannot enroll as Ordering, Referring, and Prescribing (ORP) providers and must have their supervising practitioner's NPI used for PRP referrals.
Action Required
By January 1, 2026: Billing teams at Outpatient Mental Health Clinics must ensure all PRP referrals use the supervising licensed practitioner's NPI in the Referring Provider field (17b) on CMS 1500 claims, not the LMSW or LGPC practitioner's information. Update billing systems to verify referring provider enrollment status before submitting PRP claims. Maryland Medicaid will deny all PRP claims if the referring provider is not actively enrolled.